Contributor / Volunteer Enrollment Form

SECTION A: APPLICANT INFORMATION

1. Full Legal Name: *

2. Date of Birth (MM/DD/YYYY): *

3. Gender (Optional):

Male

Female

Prefer not to say

Other:

4. Social Security Number (SSN): For background verification and compliance purposes only

SECTION B: CONTACT INFORMATION

5. Home Address (Street, City, State, ZIP): *

6. Mailing Address (if different):

7. Phone Number: *

8. Alternate Phone Number (Optional):

9. Email Address: *

SECTION C: PARTICIPATION TYPE

10. I am applying as (check one): *

Volunteer

Contributor

Both Volunteer & Contributor

11. Preferred Area of Involvement:

Community Outreach

Mental Health Awareness & Assessment

Youth & Family Counseling

Group Therapy

Administrative Support

Fundraising & Events

Media & Communications

Advocacy & Awareness

Other:

SECTION D: PROFESSIONAL & SKILL BACKGROUND

12. Current Occupation / Field of Work:

13. Employer / Organization (if applicable):

14. Relevant Skills or Experience:

15. Languages Spoken (if any):

SECTION E: AVAILABILITY

16. Availability (check all that apply):

Weekdays

Weekends

Evenings

Flexible / As Needed

17. Estimated Hours Available per Month:

SECTION F: EMERGENCY CONTACT

18. Emergency Contact Name: *

19. Relationship: *

20. Emergency Contact Phone Number: *

SECTION G: BACKGROUND & COMPLIANCE

21. Have you ever been convicted of a felony? *

Yes

No

22. Are you willing to undergo a background check if required? *

Yes

No

SECTION H: CONTRIBUTOR INFORMATION (if applicable)

23. Type of Contribution:

Financial

In-Kind (Goods/Services)

Professional Services

Other:

24. Frequency (Optional):

One-time

Monthly

Quarterly

Annual

SECTION I: AGREEMENT & CONSENT

25. Statement of Understanding:

I certify that the information provided in this form is true and accurate to the best of my knowledge. I understand that Safe Heaven Foundation Inc. reserves the right to verify information provided. I agree to abide by the organization's policies, values, and code of conduct.

Signature: *

Date: *

Safe Heaven Foundation Inc.
Contributor / Volunteer Enrollment Form

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Safe Heaven Foundation Inc. Contributor / Volunteer Enrollment Form

Safe Heaven Foundation Inc.
Contributor / Volunteer Enrollment Form